Admission Criteria

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Serving Otsego, Delaware and Schoharie Counties

What does your patient want?

  • They want to be home
  • To be free from pain and symptoms
  • To enjoy and make the most of their time left
  • An extra layer of care and support for their loved ones
  • To not be a financial burden to their loved ones
  • No more trips to the hospital or ER
  • No more invasive treatments
  • Access to personalized and specialized care 24/7
  • To be home when they die
  • 13 months of Grief Support for all family members

They want to Feel Better. They want to Live Better.

General Hospice Guidelines

  • Life-limiting condition
  • Would it surprise you if your patient died in the next six months?
  • Symptoms and signs that paint a picture of decline
  • More than one visit to the hospital/ER/office for their illness
  • Recurring infections
  • Patient/family focus on symptom relief rather than cure
  • Progression of disease(s)
  • Evidence of weight loss; serum albumin < 2.5g/dl
  • Karnofsky or Palliative Performance Scale score < 50%
  • Dependence in at least 2 ADLs
  • Progressive/unhealing stage III or IV pressure ulcers

Disease Specific Criteria for Hospice:

Two or more items in any category should generate a hospice referral.

Click on a button for criteria.

  • Cancer

  • HIV

  • Dementia

  • ALS

  • Renal Disease

  • Liver Disease

  • Malnutrition

  • Stroke-Coma

  • Cardiac Disease

  • Respiratory Disease

Source: Current CMS and NHPCO Guidelines

CANCER:

  • Clinical findings of malignancy with widespread, aggressive or progressive disease as evidenced by increasing symptoms, worsening lab values and/or evidence of metastatic disease
  • Impaired performance on Palliative Performance Scale of <70%
  • Refuses further curative therapy or continues to decline despite definitive therapy.
  • Hypercalcemia > or = 12
  • Cachexia or weight loss of 5% in the preceding 3 months
  • Recurrent disease after surgery/radiation/chemotherapy
  • Refusal to pursue additional curative or prolonging cancer treatment
  • Signs and symptoms of advanced disease (nausea, anemia, malignant ascites or pleural effusion, etc.)

RESPIRATORY/LUNG:

  • Severe chronic lung disease
  • Disabling dyspnea at rest, poorly responsive to bronchodilators
  • FEV1 after bronchodilator < 30%
  • Progression of end-stage pulmonary disease
  • Recurrent pulmonary infections
  • Hypoxemia at rest, on room air: pO2 < 55mmHg - or O2 sat < 88%
  • Right heart failure secondary to pulmonary disease
  • Unintentional progressive weight loss >10%
  • Persistent resting tachycardia

CARDIAC/HEART:

  • Symptomatic despite optimal treatment with diuretics and vasodilators
  • Recurrent CHF
  • Ejection fraction < 20%
  • New York Heart Association Class IV
  • Supporting factors
  • Arrhythmias are resistant to treatment
  • History of cardiac arrest or resuscitation
  • History of unexplained syncope
  • Cardiogenic embolic disease (e.g., CVA)

DEMENTIA:

  • Functional Assessment score = 7
  • Unable to ambulate without assist
  • Unable to dress or bathe without assist
  • Urinary and fecal incontinence, intermittent or constant
  • No consistently meaningful verbal communication
  • Complications such as aspiration pneumonia, UTI, septicemia, recurrent fevers
  • Decubitus ulcers stage 3 or 4
  • Weight loss of >10% over last six months

RENAL DISEASE:

Renal Disease – Acute Renal Failure

  • Patient is not seeking dialysis or transplant
  • Creatinine > 8mg/dl (> 6mg/dl for diabetics)
  • GFR < 10ml/min
  • Creatinine clearance <10cc/min (<15cc/min for diabetics)
  • Co-morbid conditions

Renal Disease – Chronic Renal Failure

  • Patient is not seeking dialysis or transplant
  • Creatinine clearance <10cc/min (<15cc/min for diabetics)
  • Creatinine > 8mg/dl (> 6mg/dl for diabetics); GFR < 10ml/min
  • Symptoms: uremia; oliguria; confusion; nausea; vomiting; pruritus; restlessness; hyperkalemia > 7.0, not responsive to treatment; intractable fluid overload, not responsive to treatment

LIVER DISEASE:

  • PTT > 5 seconds over control
  • Serum Albumin < 2.5gm/dl
  • End-stage liver disease
  • Ascites refractory to treatment
  • Spontaneous bacterial peritonitis
  • Hepatorenal syndrome
  • Hepatic encephalopathy, refractory to treatment
  • Supportive factors
  • Progressive malnutrition
  • Continued alcoholism
  • Hepatocellular carcinoma

STROKE/COMA:

  • Karnofsky Performance < 40%
  • Inability to maintain nutrition/hydration
  • Weight loss > 10%
  • Serum albumin < 2.5 gm/dl
  • Pulmonary aspiration
  • Severe dysphagia
  • Coma with any 3 of the following on day 3 of coma:
    • Abnormal brain stem response
    • Absent verbal response
    • Absent withdrawal response to pain
    • Serum creatinine > 1.5 mg/dl

ALS:

  • Critically impaired respiratory function
  • Dyspnea at rest
  • Use of accessory muscles
  • Respiratory rate > 20
  • Reduced speech / vocal volume
  • Unexplained headaches, anxiety or nausea
  • Severe nutritional insufficiency
  • Progressive weight loss of at least 5% of body weight with or without gastrostomy tube insertion

HIV:

  • CD4 count < 25 cells/mcl or persistent viral load >100,000 copies/ml
  • Decreased performance status
  • Supporting factors
  • Chronic persistent diarrhea
  • Persistent serum albumin < 2.5
  • Concomitant substance abuse
  • Age > 50
  • Advanced AIDS dementia complex
  • CHF or advanced liver disease

MALNUTRITION:

  • BMI <22 despite nutritional support
  • PPS = or <40%
  • Continued nutritional decline 

607.432.5525

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  • Learn about the current health circumstances and concerns for your patient

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Serving Otsego, Delaware and Schoharie counties;
542 Main Street, Oneonta, New York 13820